Health Behaviors Transportation and the Role of Hospitals

1 Social Determinants of Health Series Food Housing Education Transportation Violence Social Support Health Behaviors Employment Transportation and the Role of Hospitals November 2017. Transportation and the Role of Hospitals 1. Suggested Citation: Health Research & Educational Trust. (2017, November). Social determinants of Health series: Transportation and the role of Hospitals . Chicago, IL: Health Research & Educational Trust. Accessed at Accessible at: Contact: or (312) 422-2600. 2017 Health Research & Educational Trust. All rights reserved. All materials contained in this publication are available to anyone for download on , www. or for personal, non-commercial use only. No part of this publication may be reproduced and distributed in any form without permission of the publication or in the case of third-party materials, the owner of that content, except in the case of brief quotations followed by the above suggested citation.

2 To request permission to reproduce any of these materials, please email 2 Transportation and the Role of Hospitals Table of Contents Transportation and Transportation Vehicle Access ..8. Place, Distance and Transportation Policy and The Role of Impact on Health Care Access and Connection to Other Determinants of Making the Business Missed Decreased pharmacy access and prescriptions Economic Case CalvertHealth Medical Denver Health Medical Grace Cottage Family Health & Taylor Regional Transportation and the Role of Hospitals 3. Introduction The World Health Organization defines Health and well-being are inextricably social determinants of Health as the linked to the social and economic conditions in which people live. Research conditions in which people are born, has shown that only 20 percent of grow, work, live and age, and the wider Health can be attributed to medical care, set of forces and systems shaping the while social and economic factors like conditions of daily life.

3 3. access to healthy food, housing status, educational attainment and access to Transportation account for 40 percent Transportation barriers can affect a (see Figure 1.)1 Individuals struggling person's access to Health care services. with food insecurity, housing instability, These barriers may result in missed limited access to Transportation or or delayed Health care appointments, other barriers may experience poor increased Health expenditures and Health outcomes, increased Health care overall poorer Health utilization and increased Health care Transportation is interrelated with other costs. Addressing these determinants of social determinants of Health such Health , commonly referred to as social as poverty, social isolation, access to determinants of Health , or simply social education and racial discrimination. determinants, will have a significant Transportation also can be a vehicle positive impact on people's Health , for wellness (see Figure 2).

4 Developing including longer life expectancy, healthier affordable and appropriate Transportation Behaviors and better overall options, walkable communities, bike lanes, Transportation is an economic and social bike-share programs and other healthy factor that shapes people's daily lives transit options can help boost and thus a social determinant of Health . 10%. 30%. Figure 1: Contributing Factors of Health Health Behaviors Clinical Care Social and Economic 40% Factors Physical Environment 20%. Source: Health Research & Educational Trust, 2017. 4 Transportation and the Role of Hospitals Figure 2. Better Transportation Options Can Lead To Healthier Lives Health IN COMMUNITIES WITH. BETTER Transportation OPTIONS. Walkable, bikable, transit-oriented communities are associated with healthier populations that have: MORE LOWER LOWER RATES LESS AIR IMPROVED.

5 PHYSICAL BODY OF TRAFFIC POLLUTION MOBILITY FOR. ACTIVITY WEIGHT INJURIES NON-DRIVERS. Source: Better Transportation Options = Healthier Lives Infographic, Robert Wood Johnson Foundation, This guide explains the link between Understanding and assessing Transportation and Health and discusses how Transportation can affect the role of Hospitals and Health systems overall community Health in addressing Transportation issues, improving access and helping design Integrating support for Transportation and support better Transportation access into the organization's options. Although Hospitals and Health mission and practices systems traditionally have not focused Screening and evaluating on Transportation issues within their patients' Transportation needs purview of care delivery, there is a growing recognition that improving Providing direct Transportation Transportation access and support services through community for patients can help improve Health partnerships or programs outcomes and lower Health costs.

6 See Supporting policy and infrastructure Making the Business Case on page 12. programs that create safer and more Based on a literature review, subject accessible Transportation options matter expert reviews and interviews Four case examples in this guide highlight with four Hospitals , this guide outlines Hospitals and Health systems that are strategic approaches that Hospitals can successfully addressing Transportation use to build a healthier community that issues in their communities: addresses the physical, behavioral and socio-economic needs of individuals CalvertHealth Medical Center and families and improves population has a Mobile Health Center that Health . In doing so, Hospitals and Health provides primary and preventive systems will better position themselves care services to residents with to achieve the Triple Aim of improved Transportation challenges.

7 Health , improved care and lower Denver Health Medical Center is Strategies for Hospitals and Health partnering with Lyft to provide systems to address patients' vulnerable patients with Transportation Transportation issues include: services to and from the hospital. Transportation and the Role of Hospitals 5. Grace Cottage Family Health & Regardless of insurance status, 4. Hospital collaborates with Green percent of children (approximately Mountain RSVP in a volunteer driver 3 million) in the miss a Health program, which helps patients care appointment each year due to attend their medical appointments unavailable Transportation ; this includes and also builds community. 9 percent of children in families with incomes of less than $50 Taylor Regional Hospital operates a hospitality van service for Transportation is the third most patients in Taylor County and commonly cited barrier to accessing three neighboring counties.

8 Health services for older This guide is part of a series of resources Transportation challenges affect urban and from the Health Research & Educational rural communities. Overall, individuals who Trust (HRET) on how Hospitals and are older, less educated, female, minority, Health systems can address the social or low income or have a combination of determinants of Health to improve the these characteristics are affected more environment where people live, work and by Transportation Children, play. The American Hospital Association older adults and veterans are especially (AHA), HRET, and the Association vulnerable to Transportation barriers due for Community Health Improvement to social isolation, comorbidities, and (ACHI) are committed to supporting greater need for frequent clinician community Health and advancing Health in America through innovative Transportation issues affect people at campaigns, initiatives, partnerships, varying levels depending on how different publications and awards.

9 To view all of challenges overlap. For example, a low- the resources in the social determinants income person struggling with travel of Health series, visit may have an increased burden if he or she experiences a temporary physical disability. Limited Health literacy, Transportation and Health cognitive impairment, fragmentation Transportation connects people from their of Health history, access to Health origin to their destination, affects land use insurance, poverty or food insecurity and shapes our daily lives. Transportation can intersect at any period of time and is necessary to access goods, services affect individuals and communities. and activities such as emergency services, Health care, adequate food and clothing, Transportation Issues education, employment, and social Because Transportation touches Transportation issues include lack many aspects of a person's life, adequate of vehicle access, long distances and reliable Transportation services are and lengthy travel times to reach fundamental to healthy communities.

10 Needed services, Transportation costs, inadequate infrastructure and adverse Barriers to Transportation greatly affect the policies that affect travel. Figure quality of people's lives. These statistics 3 outlines types of Transportation highlight the scope of the problem: issues and the impact on Health care access. Like other social determinants million people in the of Health , Transportation barriers are do not obtain medical care due interconnected so the presence of one to Transportation may exacerbate or create other barriers. 6 Transportation and the Role of Hospitals Figure 3. Transportation Issues and the Impact on Health Care Access Transportation Barriers to Health Care Access Limited availability and routes Overcrowding on trains or buses Roads and transport stations in Transportation disrepair Infrastructure Safety issues Impact on Health Care High cost of fares Access and Health Personal vehicle expenses such as insurance Transportation Credit card or bank account Missed doctor and clinic Costs requirements appointments Lack of a personal vehicle Limited pharmacy access Lack of access to a vehicle through and decreased prescription Vehicle friends or family fills Access Economic burden for Long travel distances and lengthy wait times patients and the Health care Erroneous or inconvenient time system Distance and schedules Time Burden Budget cuts resulting in bus and train shortages.